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inconsistent results. What is the exact structure of the investigation? (It depends - onthe method chosen, people involved, the assigned task). What is meant by “truecause”? (It depends - how long/far do you want to dig?). What actions are necessary toeliminate the cause? (It depends - what level of cause do you want to attack? Are we tonote all identified causes? Only top level? Somewhere in between?) 5 . How deep canwe dig in this analysis? (It depends – how much time and resources (i.e.,money) areavailable?). In short, while a root cause analysis, on its face, appears to be acommendable endeavor, the details of how it will be conducted, and how far it will go,often cloud the issues before the first action is even taken.Despite the challenges discussed above, it should be noted that many, if not most,companies perform root cause analyses with some frequency. There are scores ofresources and training available on the topic. Root cause analysis has been describedas “a collective term to describe a wide range of approaches, tools, and techniques touncover causes of problems.” 6There is no one generally accepted method for rootcause analysis. 7Despite this, one must acknowledge that, for all the variables that mayinfluence the end product, the concept of a root cause analysis is well accepted. This isnot surprising. If an incident occurs, or there is a breakdown in a process, it is not onlycommendable, but (at some level) expected that a concerted effort will be undertaken tofigure out why. Yet root cause analysis differs from typical investigations to go beyondsimply the “why” and reach the issue of what can be done to prevent futureoccurrences. Root cause also does not stop at the most obvious immediate cause of5 “Root cause” has been termed the “evil at the bottom” – the trigger for all other causes. Id. At 56 Id. at 13.7 Duke Okes, ROOT CAUSE ANALYSIS: THE CORE OF PROBLEM SOLVING AND CORRECTIVE ACTION 4 (2009)(noting five methodologies for root cause analysis contained in U.S. Department of Energy guidelines).4

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